CEO SUMMARY: Yet another specialty society is opposing the laboratory benefit management program UnitedHealthcare introduced in Florida last fall. Rheumatologists have joined four other specialty physicians in saying UHC’s BeaconLBS system could be detrimental to patient care. In a letter to UHC, the Coalition of State Rheumatology Organizations said it, “will pursue the reversal of this policy with our state and national societies through every regulatory, legislative, and public means possible.”
IN FLORIDA, ADD RHEUMATOLOGISTS to the list of physicians opposing UnitedHealthcare’s implementation of a laboratory benefit management program administered by BeaconLBS, a division of Laboratory Corporation of America.
In a letter to UnitedHealthcare (UHC), the Coalition of State Rheumatology Organizations said it could not support the implementation of UHC’s Beacon Laboratory Benefit Solutions system “without data supporting the inappropriate use of laboratory testing by rheumatologists.” The coalition also said it “will do all that is necessary to controvert this policy.”
Pursuing Reversal of Policy
In the letter to UHC’s National Medical Director, Richard Justman, M.D., CSRO President Michael C. Schweitz, M.D., wrote, “We are going to suggest to our members that they investigate all ethical and legal means to resist this policy and we will pursue the reversal of this policy with our state and national societies through every regulatory, legislative, and public means possible.”
THE DARK REPORT recently obtained the letter dated September 11, 2014.
Also in September, in a letter sent to Justman by the American College of Rheumatology, Charles King, M.D., Chair of the Committee on Rheumatologic Care, wrote to say the ACR vigorously opposes the approach BeaconLBS takes to managing laboratory test orders.
“The timely diagnosis and safety of patients must not be compromised by illadvised (albeit well intentioned) systems put in place miles from the patient that subvert or hinder careful decision making by trained clinicians,” wrote King. “Often, rheumatologists are the only ones aware of the nuances of their patients’ symptoms, disease and needs. Their judgment, expertise and experience simply cannot be replaced by a computer algorithm.”
Rheumatologists are at least the fourth specialty society in Florida to complain to UHC about the difficulty physicians are having implementing UHC’s new laboratory benefit management program, administered by BeaconLBS. Represented by the Florida Society of Rheumatology, rheumatologists have joined the Florida Medical Association, the Florida Association of Family Physicians, District XII (Florida) of the American Congress of Obstetricians and Gynecologists, the College of American Pathology, and the Florida Society of Pathologists in complaining to UHC about the onerous nature of the BeaconLBS system.
Some of these physicians have have asked UHC to revise the system or discontinue it immediately and indefinitely, saying it is difficult to implement and could adversely affect patient care. (See TDRs, July 21, September 2, October 13, November 3, 2014; and January 5, 2015.)
Pamela Freeman, M.D., President of the Florida Society of Rheumatology, said in an interview with THE DARK REPORT, that rheumatologists have little choice but to use the BeaconLBS system or stop seeing UHC members.
“We have told our members that they have to choose between using the system or dropping out of UnitedHealthcare,” she said. “United has threatened to drop physicians from their practice panel or lower reimbursement paid to any physician who does not comply with their Beacon procedures.”
Issues of Appropriate Care
Freeman is part of a three-physician practice in Orlando. She stated that her colleagues have discovered that, when ordering laboratory tests for their patients who have rheumatoid arthritis and lupus, not only does the BeaconLBS system fail to accommodate the required steps, but it takes an excessive amount of time to enter such test orders. “This system is so difficult to use that it discourages physicians from looking for other health problems that our patients have,” Freeman said of the BeaconLBS system.
“When we first heard about UHC’s laboratory benefit management program, we assumed this would not be an issue for our medical practice,” she explained. “We assumed that, because our patients could have their blood drawn in our office or go to LabCorp, we wouldn’t need to use the BeaconLBS system to enter all the information needed for the Beacon system.
Use of BeaconLBS System
“But in fact, to order a lab test on the UHC list, we found we had to enter all the patient’s information into the BeaconLBS system,” continued Freeman. “This includes the ordering doctor’s name, the patient’s name, the diagnosis, and the lab test ordered. Moreover, we can’t use our electronic health system to enter this information. Instead, we must manually enter this information on the Beacon website.”
The requirement to enter lab test order information on the BeaconLBS website means physicians have to enter orders twice, once on the Beacon site and once in their own electronic health record systems. Such dual entry defeats the purpose of the federal government’s meaningful use program, which is designed to speed up data entry while making patient information available on a variety of systems.
“When we tried to use the BeaconLBS system, we found it would take several minutes to enter and get the lab test order done,” she explained. After complaints to UHC, the insurer conducted a conference call with Freeman and other rheumatologists.
“During the one-hour conference call with the executives at UnitedHealthcare, we had representatives of the American College of Rheumatology and the Florida Society of Rheumatology,” stated Freeman. “We presented all the difficulties involved in using the BeaconLBS system, but the UHC representatives said they were not willing to hold up the start date for the Beacon system.
“When it was explained that the medical assistant in our office would not be able to do all the data entry for the BeaconLBS system and keep up with the routine workflow of patients in our office, the UnitedHealthcare representatives suggested we do all the data entry for lab test orders at the end of the day,” she added. “The problem with that is my medical assistant insists on seeing her children for supper every night. The UHC executives didn’t have any answer for that problem.
Rheumatologists in Florida Seek Alternatives to Avoid Use of Beacon Lab Test Ordering System
IN FLORIDA, RHEUMATOLOGISTS are looking for ways to continue to serve their patients without having to use UnitedHealthcare’s BeaconLBS system.
Rheumatologists say that the BeaconLBS decision support system is time consuming, requires entering data twice, and, most importantly, can interfere with patient care because of the design of its lab test algorithms. But because UHC has required all physicians serving its commercial members in Florida to use the BeaconLBS system since October 1, these specialist physicians have considered different approaches to avoid having to use the BeaconLBS system.
“Some rheumatologists have talked about getting out of the United network, but we don’t want to abandon our patients,” said Pamela Freeman, M.D., President of the Florida Society of Rheumatology. “Some physicians have suggested another strategy-that they simply stop ordering any of the 80 or so laboratory tests that United says require the use of the Beacon system.
“Not ordering tests would result in a victory for United from a financial standpoint because not ordering tests would cut United’s costs,” she noted. “But also it would jeopardize patient care because rheumatologists need these lab tests to provide appropriate care to our patients.
“Some rheumatologists suggested another approach,” continued Freeman. “They said they will send their lab test orders back to their patient’s primary care physicians. That would be one way to avoid using the Beacon system. But it could delay testing and put more of a burden on PCPs and that would not be in the best interest of patients.”
Staff Overtime Required
“UHC officials said they were willing to listen to problems over time,” observed Freeman. “Essentially, that is UHC telling us that ‘you must prove that you have a problem,’ despite the fact that-at this moment-physicians already have a problem with this system!
“My medical assistant already pulls overtime and UHC has not said it would help me pay for the additional overtime required to comply with this UHC program,” she said. “Running the program interrupts physician workflow and causes extra staff overtime.
“In our office we have a medical assistant in the lab,” continued Freeman. “We offer phlebotomy for our patients and charge a handling fee for their convenience so that busy patients can get the lab testing done in our in-office laboratory rather than leaving our office to go to a LabCorp patient service center. We must frequently request blood counts, liver function, and kidney tests to monitor patients’ medications.”
The BeaconLBS system requires physicians serving UHC’s commercial patients in Florida to use the system to notify UHC when ordering any of 80 clinical laboratory tests. If physicians do not use the system to notify UHC that they are ordering any of these tests, then the lab that runs these tests may not get paid. The BeaconLBS also requires physicians ordering two tests for breast cancer (BRCA1 and BRCA2) to request preauthorization for these tests. If they do not use the system to request preauthorization, then UHC will not pay the labs that run these tests.
“Many of the 82 tests on UCH’s list don’t relate to rheumatology, but those that do are important for our patients,” noted Freeman. “Examples are tests for ANA (antinuclear antibody) and vitamin D testing. We need to run both of these for our patients in a timely fashion.”
“We use the antinuclear antibody test to help diagnose a suspected autoimmune disorder,” she said. “Similarly, with our patient population, vitamin D often needs to be assessed to ensure the level is adequate. If it’s not adequate, then the supplement dose must be changed. Many patients in Florida are vitamin D deficient.”
Problems with Algorithms
Freeman next pointed out that lab test pre-notification algorithms within the BeaconLBS system create their own problems and could negatively affect patient care. “What does a rheumatologist do when monitoring a patient and learning that a condition has changed, such as for vitamin D levels?” she asked. “When you order a vitamin D test, BeaconLBS asks you to answer two questions. The first question: ‘Is this test to diagnose vitamin D deficiency?’ But what does that mean? Do we already know it’s deficient or are we trying to find out?
“The next question in the BeaconLBS system has more than a dozen subparts to fill out, including demographics of the patient, ethnic background, and the patient’s diagnosis, including osteoporosis. It looks like the BeaconLBS algorithm wants to know if there is a reason to order the lab test.
“But what about recent research showing that adults and children with lupus–who are vitamin D deficient–don’t do as well as those who have sufficient vitamin D? That clinical study indicates that we should check the vitamin D level for lupus patients. But, in BeaconLBS, that’s not one of the boxes to check. The algorithm does not address all the reasons a rheumatologist would order a vitamin D test,” she concluded.
Rheumatology Groups Send Complaints to UHC
IN LETTERS TO UNITEDHEALTHCARE, the presidents of two groups representing rheumatologists in Florida criticized UnitedHealthcare’s pilot laboratory benefit management program and the BeaconLBS system that is part of the program as having the potential to negatively affect patient care.
BeaconLBS is a decision support system for lab test ordering that UHC says all physicians must use when ordering any of certain lab tests for its commercial patients in Florida.
“This policy will create an administrative burden on practicing rheumatologists, requiring the devotion of time and resources by the physicians and their staffs to obtain the authorization necessary to have certain rheumatologic tests performed,” wrote Michael C. Schweitz, M.D., President of the Coalition for State Rheumatology Organizations. “Requiring trained certified specialists to obtain authorization from a less qualified person or entity using a rote, inflexible algorithm is not only unnecessary but insulting.”
In a letter from the American College of Rheumatology, Charles King, M.D., president of ACR’s Committee on Rheumatologic Care, explained that the BeaconLBS system requires physicians to enter lab test orders twice. “Requiring clinicians and their staff to leave a patient’s chart, access a separate portal, and obtain prior authorization to order a test, all post obvious barriers that will, predictably, increase administrative costs for practicing clinicians. But any barrier that prevents appropriate laboratory testing will also increase costs in other ways, many of which will be borne by payers,” he wrote.
Contact Pamela Freeman, M.D., at pameheu@AOL.com or 407-859-4540.